Provider First Line Business Practice Location Address:
14466 N 169 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64089-9042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-532-2090
Provider Business Practice Location Address Fax Number:
816-532-2099
Provider Enumeration Date:
05/09/2006